A shunt is a device that moves excess cerebrospinal fluid (CSF) from the brain or spine to another part of the body where it can be safely absorbed. The surgical procedure to implant a shunt system is relatively short and is performed in the operating room under general anaesthesia by a neurosurgeon.
There are three kinds of shunts: Your consultant will select the most appropriate for your individual needs.
Ventricular-Peritoneal (VP) Shunt
For this type of shunt, a small hole is made in the skull, allowing the neurosurgeon to place a ventricular catheter or tube in the ventricle. Here it collects excess CSF and takes it away from the brain under the control of a pressure valve. The valve is implanted under the scalp, normally behind the ear. The CSF then travels down another catheter that is tunnelled under the skin to the abdominal cavity, where it is reabsorbed by the lining (peritoneum).
Ventricular-Atrial (VA) Shunt
This shunt also collects CSF from the ventricle in the brain via a controlling valve but discharges excess fluid into the heart instead of the abdomen. The neurosurgeon introduces the catheter through an incision in the neck and passes it through various blood vessels until it is positioned in the right atrium of the heart.
In this shunt, excess CSF is taken from the spine rather than the brain. The neurosurgeon makes an incision in the lumbar region and the catheter is inserted between two of the vertebrae of the spine into the subarachnoid space containing CSF. The valve unit and associated tubing are placed under the skin between the lumbar region and the abdomen where, via another incision, the fluid is discharged.
After the Operation
Your wounds may be closed with metal clips, sutures or steristrips. If these aren’t removed while you are on the hospital ward, these will need to be taken out by the nurse at your GP/family doctor surgery. You’ll be advised when this should be done when you leave hospital.
Observe the wounds for any signs of infection such as unusual redness or pain, swelling, heat or discharge. Contact your specialized hydrocephalus nurse or your doctor, if you notice any of these symptoms.
It may be necessary to inform the relevant Driving and Vehicle Licensing Agency (DVLA in the UK for example) about your shunt. This is particularly important if you have a VP shunt. In the UK, At present, you must not drive for six months if you have had a VP shunt. However, this can be longer if there are other influencing medical conditions or disabilities.
An outpatient appointment will be sent to you following your shunt procedure. Please contact the secretary of your Neurosurgeon or the specialized hydrocephalus nurse if you don’t receive this follow up appointment.
Frequently asked questions
Watch for the following:
- Nausea and vomiting
- Visual disturbances
- Drowsiness or difficulty waking
- Raised temperature
- Worsening memory
- Balance problems or unsteadiness on feet
- Worsening concentration
- Return of pre-shunt issues
If you experience any of these it could mean your shunt is infected or blocked and you should contact your Hydrocephalus Nurse Practitioner or GP without delay. If out-of-hours, go to your nearest Emergency Department and inform the staff that you have a shunt.
You’ll usually be discharged within one day of your surgery. Shunt patients do need a period of recovery and if they are employees, it can be helpful for them to discuss this in advance with their employers.
If you have been fitted with a VP or VA shunt system, you’ll feel a small bump under the skin behind the ear where the valve is located. However, it’s not usually visible under hair.